Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain

Prosky, Jordan; Cagle, Jackson N.; Sellers, Kristin K.; Gilron, Ro’ee; Hemptinne, Cora de; Schmitgen, Ashlyn; Starr, Philip A.; Chang, Edward F.; Shirvalkar, Prasad

doi:10.3389/fnins.2021.762097

Cited by 12 publications

(10 citation statements)

References 29 publications

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“…Sensing during stimulation is technically challenging, since the amplitude of the stimulus artifact is several fold higher than that of the neural signals used for adaptive control, and thus requires a different device design 33 . The successful implementation of our methodology for PD provides a framework for configuring adaptive neurostimulation that may be extended to several other neuropsychiatric disorders, many of which are currently under investigation but have not yet shown superior benefit compared to cDBS at home during normal daily activities 34 .…”

Section: Discussionmentioning

confidence: 99%

Personalized chronic adaptive deep brain stimulation outperforms conventional stimulation in Parkinson’s disease

Oehrn

Cernera

Hammer

et al. 2023

Preprint

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1.AbstractDeep brain stimulation is a widely used therapy for Parkinson’s disease (PD) but currently lacks dynamic responsiveness to changing clinical and neural states. Feedback control has the potential to improve therapeutic effectiveness, but optimal control strategy and additional benefits of “adaptive” neurostimulation are unclear. We implemented adaptive subthalamic nucleus stimulation, controlled by subthalamic or cortical signals, in three PD patients (five hemispheres) during normal daily life. We identified neurophysiological biomarkers of residual motor fluctuations using data-driven analyses of field potentials over a wide frequency range and varying stimulation amplitudes. Narrowband gamma oscillations (65-70 Hz) at either site emerged as the best control signal for sensing during stimulation. A blinded, randomized trial demonstrated improved motor symptoms and quality of life compared to clinically optimized standard stimulation. Our approach highlights the promise of personalized adaptive neurostimulation based on data-driven selection of control signals and may be applied to other neurological disorders.

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Section: Discussionmentioning

confidence: 99%

Personalized chronic adaptive deep brain stimulation outperforms conventional stimulation in Parkinson’s disease

Oehrn

Cernera

Hammer

et al. 2023

Preprint

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“…DBS has been used for the treatment of chronic pain since the early 1970s, but it remains off-label in the United States and its indications are contested ( Falowski, 2015 ). This technique has the capacity to modulate the activity of neural circuits associated with pain processing and perception ( Falowski, 2015 ; Prosky et al, 2021 ; Alamri and Pereira, 2022 ). Although the precise mechanism underlying the pain-relieving effects of DBS remains incompletely understood, it is believed to involve various factors.…”

Section: Discussionmentioning

confidence: 99%

“…Although the precise mechanism underlying the pain-relieving effects of DBS remains incompletely understood, it is believed to involve various factors. These include the alteration of the balance between inhibitory and excitatory neurotransmitters within pain pathways, the reduction of activity in nociceptive signal-transmitting neurons, the enhancement of endogenous opioid systems responsible for mediating analgesia ( Prosky et al, 2021 ; Alamri and Pereira, 2022 ), and the modification of emotional and cognitive aspects of pain such as anxiety, depression, and catastrophizing ( Falowski, 2015 ; Prosky et al, 2021 ; Alamri and Pereira, 2022 ). The effects of DBS on chronic pain relief may vary depending on the specific brain target utilized.…”

Section: Discussionmentioning

confidence: 99%

“…The effects of DBS on chronic pain relief may vary depending on the specific brain target utilized. Some common targets include the sensory thalamus (ST), (ventral posterior lateral and ventral posterior medial), which is primarily associated with sensory-discriminative pain aspects such as location, intensity, and quality ( Falowski, 2015 ; Prosky et al, 2021 ; Alamri and Pereira, 2022 ). the periaqueductal gray and periventricular gray matter, involved in descending pain modulation and endogenous opioid release; and the ACC, implicated in affective-motivational pain aspects such as unpleasantness, suffering, and coping ( Falowski, 2015 ; Prosky et al, 2021 ; Alamri and Pereira, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

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Deep brain stimulation for chronic pain: a systematic review and meta-analysis

Shaheen,

Elgendy

et al. 2023

Front. Hum. Neurosci.

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BackgroundDeep brain stimulation (DBS) has shown promise in effectively treating chronic pain. This study aimed to assess the efficacy of DBS in this context.MethodsWe conducted a systematic literature search using PubMed, Scopus, and Web of Science, following the PRISMA guidelines. A well-constructed search strategy was utilized. Our literature search identified two groups of subjects: one group underwent DBS specifically for chronic pain treatment (DBS-P), while the second group received DBS for other indications (DBS-O), such as Parkinson’s disease or dystonia, with pain perception investigated as a secondary outcome in this population. Meta-analysis was performed using R version 4.2.3 software. Heterogeneity was assessed using the tau^2 and I^2 indices, and Cochran’s Q-test was conducted.ResultsThe analysis included 966 patients in 43 original research studies with chronic pain who underwent DBS (340 for DBS-P and 625 for DBS-O). Subgroup analysis revealed that DBS-P exhibited a significant effect on chronic pain relief, with a standardized mean difference (SMD) of 1.65 and a 95% confidence interval (CI) of [1.31; 2.00]. Significant heterogeneity was observed among the studies, with an I^2 value of 85.8%. However, no significant difference was found between DBS-P and DBS-O subgroups. Subgroup analyses based on study design, age, pain diseases, and brain targets demonstrated varying levels of evidence for the effectiveness of DBS across different subgroups. Additionally, meta-regression analyses showed no significant relationship between age or pain duration and DBS effectiveness for chronic pain.ConclusionThese findings significantly contribute to the expanding body of knowledge regarding the utility of DBS in the management of chronic pain. The study underscores the importance of conducting further research to enhance treatment outcomes and elucidate patient-specific factors that are associated with treatment response.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=428442, identifier CRD42023428442.

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“…Such an adaptive, or closed-loop, approach has been introduced for intracranial [13,14,15] and transcranial stimulation [16]. Recently proposed closed-loop methods are adaptive in the sense that a pre-defined stimulation signal is applied when observed brain activity fulfills certain criteria, such as passing an amplitude or power threshold.…”

Section: Introductionmentioning

confidence: 99%

Delayed closed-loop neurostimulation for the treatment of pathological brain rhythms in mental disorders

Wahl¹,

Riedinger²,

Duprez³

et al. 2023

Preprint

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Mental disorders (MD) are among the top most demanding challenges in world-wide health. According to the World Health Organization, the burden of MDs continues to grow with significant impact on health and major social and human rights. A large number of MDs exhibit pathological rhythms, which serve as the disorders characteristic biomarkers. These rhythms are the targets for neurostimulation techniques.Open-loop neurostimulation employs stimulation protocols, which are rather independent of the patients health and brain state in the moment of treatment. Most alternative closed-loop stimulation protocols consider real-time brain activity observations but appear as adaptive open-loop protocols, where e.g. predefined stimulation sets in if observations fulfil pre-defined criteria. The present theoretical work proposes a fully-adaptive closed-loop neurostimulation setup, that tunes the brain activities power spectral density (PSD) according to a user-defined PSD. The utilized brain model is non-parametric and estimated from the observations via magnitude fitting in a pre-stimulus setup phase. Moreover, the algorithm takes into account possible conduction delays in the feedback connection between observation and stimulation electrode. All involved features are illustrated on pathological αand γ-rhythms known from psychosis. To this end, we simulate numerically a linear neural population brain model and a non-linear cortico-thalamic feedback loop model recently derived to explain brain activity in psychosis.

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Practical Closed-Loop Strategies for Deep Brain Stimulation: Lessons From Chronic Pain

Cited by 12 publications

References 29 publications

Personalized chronic adaptive deep brain stimulation outperforms conventional stimulation in Parkinson’s disease

Personalized chronic adaptive deep brain stimulation outperforms conventional stimulation in Parkinson’s disease

Deep brain stimulation for chronic pain: a systematic review and meta-analysis

Delayed closed-loop neurostimulation for the treatment of pathological brain rhythms in mental disorders

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